peds Flashcards
cleft lip
1:1290 incidence
white roll
junction between skin and dry vermillion
red roll
junction between dry and wet vermillion
bilateral cleft and prolabium
use to reconstruct the tubercle, do not include any white roll, just skin
for 3mo use 6-8mm
5 years 9-11mm
adult 12-15mm
you will have bilateral tubercle flaps and no c flap
otherwise mark same as unilarteral in principle, can keep the wet mucosa as needed
bilateral cleft lip pits
Van der woude syndrome
AD
multidisciplinary team (CUPID)
plastics surgery, ENT, speech, child psych, audiology, genetics, meds dentistry, orthodontics, OMFS, SW
when to repair cleft lip? rule of 10s
10lb weight
10hgb
10weeks
ok to delay due to NAM
simonart band
weblike band connecting medial and lateral elements
weight gain pace
half pound every other week after 2wks of life
bilateral cleft lip the prolabium marked 2-2.5mm apart on the lower boarder forming the cupids bow. It narrows as it approached the columella generally 6-8mm
ZONA PELLUCIDA
diastasis of the levator muscles
questions to ask parents re prenatal
drug exposure (seizure meds, steroids), alcohol, smoking, illicit drug use, gestational age? family hx of orofacial cleating? feeding? weight gain?
look at mandible, look at hands and feet, full physical, genetic testing, kidney US, echo, X-ray of spine
cleft palate without cleft lip has a 40% incidence of syndromic presentation
Haberman bottle
part between the reservoir that you can squeeze to pass milk along into the teat
primary palate
anterior to incisive foramen
Bardach repair (two flap palatoplasty)
raise two mucoperiosteal flaps based of the greater palatine vessels,
vomer flap
septomucosal flaps raised and used to help close the nasal mucosa
tensor vili palatini and levator vili palatini
TVP goes around hamulus
draw a furlow
PRS
glospotosis, micrognathia, airway obstruction
Micrognathia
bronchoscopy, nasal endoscopy, look for anatomic causes aside from jaw
sleep study
CT
laryngomalacia, tracheomalacia, subglottic webs
distraction
begin the next day for kids
wait 5 days for older patients
rate is 2mm/day for neonates
1mm/day for adults
consolidation 4-8 weeks
confirm ossification on xray
microtia
description of small, malformed,hypoplastic residual cartiladge
unilateral? bilateral? anotia?
eam absent? hearing loss? BAHA?
hx of cleft? hand conditions? craniofacial anomalies?
Visual impairment - oculoauriculovertebral ssyndrome
Renal - brachio-oto-renal syndrome
Cardiac - CHARGE
hemifacial microsomia? Goldenhar? (epibulbar dermoid and pre auricular skin tags)
Goldenhar - malar hypoplasia, micrognathia
Nager - high nasal bridge and broad thumb
STUDIES?
CT, audiometric studies
USUALLY HAVE HEARING LOSS NOT SENSINEURAL»»SO DO BAHA PRIOR TO RECONSTRUCTION
ISSUES WITH NAGATA?
pneumo, chest contour, infection, chrondrities, residual asymmetries,
PERFORM MIDDLE EAR RECONSTRUCTION BEFORE EXTERNAL EAR
PROTECT PATIENT HEARING TO ASSURE THEIR SPEECH DEVELOPS OK`
nasoendoscopy reveals lack of lateral pharyngeal and posterior pharyngeal wall motion
spinner pharyngoplasty…..with bilateral palatopharyngeaus/posterior tonsillar pillar flaps transposed horiont\zally to a transverse incision made at the junction of the posterior pharyngeal mucosa and adenoid tissue at the level of the atlas
